Leave No Man Behind: Innovations in Combat Casualty Care

By Jenna Haines
Friday, May 31, 2019
Specialty: 

The U.S. Army Institute of Surgical Research (USAISR) helps save the lives of wounded warriors through extensive research and contributions to advanced medical technologies and techniques.

Since its inception in the 1940s, the USAISR has been tasked with the development of new surgical techniques and medical equipment designed to treat and rehabilitate combat wounded. These advancements have helped modernize both combat casualty care and the capabilities of civilian trauma centers throughout the U.S.

A Pioneer in Blood-Loss Management

In addition to the establishment of the USAISR Burn Center, a global pioneer in the treatment of thermal injuries; the development of the DOD Trauma Registry — a tool that helps collect data from medical records from overseas contingency operations — and the creation of the Burn Navigator, a machine that helps guide and monitor fluid resuscitation for severe burn patients, the USAISR’s research has had a significant impact on the science of blood-loss management.

“In the late 1990s, there really were no advanced tourniquets,” says Anthony E. Pusateri, PhD, Director of Research and Chief Science Officer at the USAISR at Joint Base San Antonio–Fort Sam Houston. “That’s been completely transformed by the work led by the USAISR. Since the early 2000s, every service member has carried very effective tourniquets. These modern tourniquets, such as the Combat Application Tourniquet or C-A-T, have also been incorporated into civilian emergency care, including in the Stop the Bleed campaign, a national awareness initiative started under President Barack Obama.”

In collaboration with researchers from other military agencies, the USAISR’s work has also led to improvements in hemostatic dressings and the development of Resuscitative Endovascular Balloon Occlusion of the Aorta, a minimally invasive technique in which a balloon catheter is inserted into the femoral artery and maneuvered to the aorta, where it is temporarily inflated to stop internal bleeding before surgery can be performed.

More recently, the USAISR contributed to the relatively new concept of balance transfusion and the innovation of cold-stored platelets. According to Pusateri, platelets traditionally can be stored for four to seven days, but cold-stored platelets can last 14 to 21 days. As a result, platelets can be collected at blood centers in the U.S. and delivered to remote combat locations.

“Much of the USAISR’s research into combat casualty care can be directly adopted by trauma centers in the civilian sector. We are not an island. We work through partnerships with other departments, agencies and outside industries.”
— Anthony E. Pusateri, PhD

The Frontlines of the Future

While many of these recent innovations have been directly influenced by current conflicts in countries like Iraq and Afghanistan, Pusateri says the USAISR is beginning to shift the focus of future research toward potential conflicts in which the U.S. may lack air superiority.

“Not having air superiority means we might have to sustain casualties for up to 72 hours before a warfighter can get to a surgeon and receive full ICU care,” Pusateri says. “This is causing us to consider two questions: How do we make the things that have been effective for us in the one to two hours before surgery work for longer periods of time, and how do we move the capabilities of the hospital closer to the field where our patients are injured? The future is prolonged care.”


To learn more about the ISR and career opportunities in Army Medicine, please call 210-692-7376. For more information about the USAISR, visit usaisr.amedd.army.mil.